Providers, payers need to move beyond compliance with FHIR interoperability, experts say. Here's why

Industry leaders argue that a stronger push for interoperability in healthcare will lead to a better understanding of population health and improved care delivery, where easily shareable data can be complemented by artificial intelligence. 

The Fast Healthcare Interoperability Resource (FHIR) standard, created by the standards development organization Health Level 7, aims to improve data sharing in a healthcare system full of fragmentation. FHIR is a core data standard, where participating entities agree on the meaning of the data and how to share the information.

In the spring of 2020, the federal government published a rule regulating the 21st Century Cures Act application programming interface (API) requirement, along with protections against information blocking. That regulation aims to give patients easier access to their digital health records through their smartphones and requires health IT vendors, providers and health information exchanges to enable patients to access and download their health records with third-party apps. 

By year-end 2022, most electronic health record (EHR) systems are required to update their software to support the Bulk FHIR API standard, which allows data to flow in batches at a population level. 

But, experts caution, steps need to be taken to ensure the standard is not solely treated as a compliance requirement. To have a positive effect on outcomes, organizations should go further, committing to not only share health data but also contextualize them to drive better health outcomes. 

How FHIR serves providers

In order to transform the cost and quality of care being delivered, clinicians need better access to patient data across settings of care. In siloed systems, that is not possible without interoperability, experts say.

“If your data is locked away, then you have these gaps,” explained Amy Shellhart, chief solutions officer at WellSky, a healthcare software company. Those gaps are like blind spots for providers and heighten the risk of an adverse event. Liberating those data under one standard allows providers, payers and patients to see a full snapshot of a care journey and not just pieces of it.

But information sharing should be leading to better care. Making sure data are not only available but also relevant at the point of care is really critical to clinical decision-making. If translated data sit in a folder that never gets opened, it is not meaningful.

“Ultimately all I care about is: Show me the outcomes,” said Brad Younggren, M.D., chief medical officer of 98point6, a text-based primary care provider. “As you pull data into a care delivery platform, I think one of the key features of the next generation is what information is being displayed for the provider in the moment.” 

One way to think about interoperability “is not interoperability for interoperability’s sake,” echoed Joe Ganley, vice president of government and regulatory affairs at health IT company Athenahealth. “It’s got to be about improving healthcare and focusing on the goals we have in healthcare.” 

With the amount of administrative burden that accompanies complex transactions, Athenahealth is thinking about how to leverage technology to make clinicians’ work easier so they can focus on caring for patients, Ganley explained. Connectivity is just the technical piece, but there must also be practical application as well. 

Ganley pointed to the Biden administration’s efforts around health equity, reminding organizations to work in service of those goals by considering to what end two disparate systems are being connected. 

“The ability to see patient data from multiple patient systems in real-time— that's truly the driver of interoperability,” said Randy Fusco, chief technology officer for healthcare at TEKsystems, an IT service management firm. 

While interoperability as a concept has been around for a long time, Fusco added, the FHIR standard has ushered in a new, superior way of sharing those data: “It’s showing itself in value.” The embrace of FHIR appears to have taken hold during the pandemic.

This era of information exchange among organizations is here to stay, Fusco argues. “It would behoove them to start getting an early jump on these mandates, because they’re not going away,” he said.

But entities have more than simply regulatory incentive to transition to FHIR, Shellhart noted. The standard allows unstructured data to be shared more easily and has helped to reduce administrative burden and improve clinical workflows. 

“There’s all kinds of good reasons to move to data on FHIR. It just so happens that it’s also a regulatory [requirement]," she said.

Payers also have a role to play

Despite the volume of claims data payers have, they may not be thinking of using it to track population health. Yet each patient’s history is a care journey, said Don Searing, Ph.D., vice president of product and solutions architecture at HGS Healthcare, a business process management firm. 

Payers can contribute data analytics to drive better care management and “become a bit more than just a pocketbook in the industry,” Searing said. To do so first requires a complete data set. Companies like HGS Healthcare aggregate data from payers, providers and third parties like wearable devices and use artificial intelligence to build risk models. Those assessments can predict comorbidities or events like a patient’s risk of falling, for example, and can help drive interventions before they happen, Searing explained.

This benefits not only the patient and their care team but also the payer, which can actively prevent events and “not just pay for them when they happen.” In effect, this “helps align more of the stakeholders in the industry in the same way," he said.

Since there are privacy challenges and the potential for discrimination, Searing acknowledged, it needs to be clear who owns the data and how they will protect the information. Another tricky task is figuring out how best to share actionable data without confusing a patient. “Giving people more data doesn’t necessarily make them more informed,” Searing noted. The best approach is involving the care team, which can contextualize the findings and decide the best course of action. 

Ultimately, the FHIR standard is just setting the stage for the next set of opportunities, Searing said. There is potential to change the model of care delivery by building layers of intelligence on top of shareable data that help providers “consume more of that data without burying them under it.”